CHOOSING WISELY VIRGINIA

Background

In 2013, the Choosing Wisely (CW) initiative was launched by the American Board of Internal Medicine (ABIM) Foundation and Consumer Reports. Recognizing that overuse stems from both clinician and patient misinformation and economic disincentives to do less, CW has developed educational campaigns to inform clinicians and consumers about unnecessary tests and procedures through partnerships with consumer organizations and medical societies. This national effort has effectively raised awareness to help patients and clinicians understand that more care is not always better.

With the advent of a state All-Payer Claims Database (APCD), it is now possible to show healthcare systems and clinicians where unnecessary testing and procedures occur, who orders and performs these tests and procedures, and the characteristics of patients who have unnecessary care. Virginia is a national leader in this effort.

VCHI and Virginia Health Information, the administrator of Virginia’s APCD, partnered with Milliman to employ a tool called the MedInsight Health Waste CalculatorTM (commonly referred to as the CW calculator) that can show health systems, practices, and even clinicians the above information as it pertains to them. The underlying clinically nuanced algorithms in the CW calculator analyze claims, billing, or electronic medical record data in order to identify potentially wasteful services as well as appropriate services. Tests and procedures are identified as necessary (confirms that data suggests appropriate services were administered by the clinician), likely to be wasteful (indicates the need to question the appropriateness of services rendered, and wasteful (flags a cause for concern, as the service probably should not have occurred).

Utilizing claims data from 5.5 million patients in 2015, the Virginia Center for Health Innovation (VCHI) found more than 1.66 M unnecessary services were provided across 45 test and procedure codes. Twenty-five percent of all patients received at least one unnecessary service in the past year alone.

The next step is to ensure that health systems have access to this information to support data driven interventions that address root causes of overuse. VCHI and our partners are currently exploring opportunities to advance this work.